- Independent providers are receiving substantial public funds to help shift the backlog in diagnostics, amidst fears of long term arrangements
- NHS radiology staff are understaffed by 33% and equipment is failing.
- Review says private sector use should be a stop gap, alongside calls to divert public funds away from firms and towards the NHS
Headline-grabbing short-term funding for local partnerships with independent providers, rather than long-term investment in staffing and capital equipment for the public sector, increasingly appears to be the government’s preferred approach to easing the crisis in diagnostic services.
The government’s latest initiative – trumpeted by health secretary Sajid Javid as a major boost to the diagnostics sector, and part of the ‘levelling up’ agenda – came last week with a relatively paltry ‘injection’ of £248m to digitise scan and test results, designed to speed up diagnoses, enable earlier treatments and reduce waiting lists.
The move – accompanied by another dig at the primary care sector, as the funding will also back the launch of a referral tool to ‘help’ GPs reduce ‘inappropriate’ test requests – was greeted with little enthusiasm by the BMA, whose spokesperson suggested solving workforce issues first was essential to making the best use of any new technology.
That stance has been echoed by others in the diagnostics sector – in July the National Breast Imaging Academy reported that staff shortages had led to several breast units closing – and is supported by the most recent census by the Royal College of Radiologists (RCR), published in April.
This survey found that the NHS’ radiologist workforce is now under-staffed by 33 per cent and needs at least another 1,939 consultants to meet safe staffing levels and pre-covid levels of demand – and that the shortfall was predicted to hit 44 per cent by 2025. More than half (58 per cent) of senior radiologists responding said they didn’t have enough staff to keep patients safe, and the RCR calculates there are just nine radiologists per 100,000 people, compared with an average of 12 per 100,000 across Europe, with the shortfall leading to diagnostics being outsourced overseas.
And last month RCR president Dr Jeanette Dickson told charity Breast Cancer Now that, “Breast imaging and treatment services were massively under-resourced even before the pandemic hit. Now, screening teams are trying to fit two years’ worth of appointments into one to catch up with a backlog of millions, while struggling with long-standing staff shortages and woefully substandard facilities… Ultimately, we cannot get away from the need to invest in people. The NHS needs more imaging and oncology staff to ensure future breast cancer patients get the care they deserve.”
A potentially much bigger windfall than Mr Javid’s £248m – perhaps for the independent diagnostics sector as much as for the NHS, although exactly how the cash will rain down on recipients is as yet unclear – was announced in last month’s budget.
According to one newspaper report, more than a third – that’s £2.3bn – of chancellor Rishi Sunak’s £6bn package of support for the NHS will go towards setting up 56 community diagnostic hubs (CDHs) England, taking the total number to 100, to help clear the tests backlog in time for a 2024 general election.
But as is often the case with funding announcements for the NHS, there is some confusion over numbers. Pulse Today reported at the beginning of October that 40 new CDHs would open across the country by next March, as part of a £350m plan already being funded from NHS England’s (NHSE) existing budget. And earlier this year, in July, news emerged of NHSE’s call for bids to run 150 new CDHs would come within a £10bn framework contract tender.
Whatever the numbers, however, CDHs are being positioned by NHSE and the government as the solution to the backlog crisis in the diagnostics sector. Although the CDH concept was piloted in ten areas back in 2018, it gained considerable traction following publication of the NHSE-commissioned review of diagnostic services last October. This review – a leaked version of which was reviewed in The Lowdown following publication by news site HSJ – was led by Professor Sir Mike Richards and offered a useful breakdown of what was required to bring the diagnostics sector back up to speed after the pandemic.
Noting a marked increase in breaches of the six-week diagnostic standard over the previous two years, matched by a substantial rise in the outsourcing of imaging requirements, the review called for a major expansion of capacity – in both workforce and scanner provision – as soon as possible, but recommended the increased use of independent sector facilities only during what it termed the ‘recovery phase’.
The review made much the same points as the BMA and RCR did a year later, suggesting workforce issues were a major constraint on the sector. It also highlighted the fact that England lags far behind the OECD averages for scanners – a situation only made worse by many NHS trusts having to rely on charity efforts to buy large diagnostic equipment, and by the sort of equipment performance issues uncovered during a Channel 4 documentary last month.
The Dispatches production team revealed that CT and MRI scanners older than ten years, potentially putting patients’ health at risk, are still being used by about a third of hospital trusts, despite an NHSE report published last year that recommended that all imaging equipment aged ten years or older be replaced. The programme makers found that coroners were concerned about the shortage of radiology staff, as well as poor CT and MRI scans. More worryingly, they also found 48 reports over the past five years that mentioned a lack of scans and/or radiology staff in relation to the death of a patient.
Unfortunately, Professor Richards’ recommendation that cash-and equipment-rich independent sector facilities should not have a role long-term in the NHS’ diagnostics capability looks increasingly unlikely to be adopted, as private equity starts to bolster the outsourcing market and enable independents to partner NHS trusts to run CDHs on a more permanent basis.
A Royal College of Pathologists survey, featured in the Richards review, found that 45 per cent of histopathology labs were having to outsource work because of staff shortages, and just last month the RCR predicted that the NHS could waste £420m by 2030 if it continues with expensive outsourcing and overseas recruitment to plug the UK’s shortage of radiologists and clinical oncologists.
And earlier this month the FT reported that the NHS is outsourcing analysis of patient scans as far afield as Australia, amid an acute shortage of radiologists in the UK. It quotes experts in Australia and New Zealand who claim about 14 per cent of scans are now being outsourced, up from five per cent six years ago. Management consultancy LEK says this figure rises to 80 per cent for out-of-hours services.
According to the RCR, 91 per cent of trusts and health boards sent a proportion of their scan workload to ‘tele-radiology’ companies in 2020, spending £206m, but a spokesman for the college told the newspaper that although private-sector involvement was currently vital to managing immediate demand, “more and more outsourcing to external suppliers is not the cure for insufficient radiologists on the ground”.
There are currently ten tele-radiology providers in the UK, says the FT, all using NHS-trained radiologists working from home. In September one such company put out a press release headlined, “Tele-radiology start-up Hexarad tackles medical imaging crisis.” Founded in 2016 by a group of NHS consultant radiologists, adopting what it describes as an “intelligent outsourcing” business model, Hexarad clearly seems confident of expanding its market, having recently closed a £2.3m funding round, which included a £1.7m growth capital investment from private equity and infrastructure investment manager Foresight Group.
With a major expansion of the CDH concept now underway, however, outsourcing isn’t the only way the independent sector is increasingly moving into NHS community diagnostics – public-private partnerships are taking off too, on the back of CDHs.
Last month saw the launch of the Rutherford Diagnostics Centre in Taunton – run by Rutherford Diagnostics Ltd, a subsidiary of Rutherford Health, in a five-year partnership deal with Somerset NHS Foundation Trust, and the company plans four more CDHs under a £55m agreement with “infrastructure investor and developer” Equitix, whose CEO in the accompanying press release described the Taunton facility simply as an asset being added to his company’s investment portfolio.
There will undoubtedly be other such partnerships emerging over the next six months as more CDHs are established across the UK, potentially favouring the independent sector in much the same way as the ‘mega lab’ Lighthouse diagnostics project – covered extensively by The Lowdown over the past 12 months – has already appeared to have done.
So it’s worth keeping an eye on whose diagnostic pockets Mr Sunak’s £2.3bn Budget bonus ends up in.
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